Altogether 3434 students of government-run residential schools in Kandhamal district [Odisha state] have tested positive for malaria.

"The affected students have been administered drugs. The health officials are keeping a watch on their condition," said collector (Kandhamal) Yamini Sarangi.

Official sources said blood samples of 19 767 students of 214 residential schools run by ST [scheduled tribes] and SC [scheduled castes] development department in the district were tested between [6 Jul and 3 Aug 2015].

The collector directed the health officials to conduct the tests after 65 of 143 students of a primary residential school at Ranipathara in Khajuria block [Odisha] were found suffering from the vector-borne disease last month [July 2015]. The incidence is more in Khajuripada, Phiringia, Daringbadi blocks [Odisha], the sources said. On [Fri 14 Aug 2015], the collector launched a 3-month malaria, dengue, and diarrhoea awareness drive and said the focus will be on schoolchildren.

"The accredited social health activists and other health workers will follow up the programme. They will immediately refer such cases to government hospitals," said chief district medical officer Sapaneswar Gadanayak. The students will be sensitized on the causes of the vector-borne disease, he added.

The programme will start with indoor residual spraying (IRS) in all hostels and schools to check malaria outbreak. "We will provide medicated mosquito nets to the inmates and persuade them to use these," said district consultant, National Vector Borne Diseases Control Programme, Kumuda Chandra Sahu.

Kandhamal has witnessed 2 malaria deaths this year [2015]. 6 persons had died of the vector-borne disease the previous year [2014].

– With porous borders and disease outbreaks inside and around Uganda, authorities are using Twitter to speed up response times

By Halima Athumani

KAMPALA, Uganda – Uganda’s Ministry of Health is using Twitter to collect real time information about disease outbreaks in the East African country.

In an exclusive interview with Anadolu Agency at the Public Health Emergency Operations Center in Kampala, Dr. Issa Makumbi said: “We set up this center in July 2013 because of the constant disease outbreaks and we needed to prepare and cope with them more effectively and efficiently.”

The World Health Organization’s Department of Global Capacities, Alert and Response established the Public Health Emergency Operations Center Network in order to strengthen global collaboration and WHO member states’ capacity for effective responses to public health hazards.

“Ebola and Marburg were rampant at the time and since then we have had five Ebola outbreaks and three Marburg outbreaks,” Dr. Makumbi, the center’s manager, said.

Uganda is currently battling a malaria outbreak in its north that has left over 167 people dead and another 22,000 infected.

Dr. Makumbi said: “These diseases are not going to go away tomorrow, so the solution is to detect and respond to them early so as to stop their transmission to vulnerable communities.”

He added that Uganda adheres to International health regulations that call for the control of disease outbreaks so as to maintain national public health security and in turn contribute to global health security.

Sam Kasozi, an information systems expert at the Emergency Operations Center, told Anadolu Agency: “With our Twitter handle @MOHUg_PHEOC we follow many local and international accounts but with an emphasis on those that pertain to Uganda and outbreaks.”

Inside the center, there are two large screens, one airing normal television and the other Twitter.

“So we have priority diseases and our surveillance focuses on Marburg, meningitis, yellow fever, West Nile virus and Rift Valley virus,” he said.

The next Twitter column is for prevailing outbreaks such as malaria, cholera, rubella, Middle East Respiratory Syndrome (MERS) and measles.

“We separate them so that we can easily pick out an outbreak and quickly respond to it,” he said.

The last column is used to detect International disease outbreaks especially from neighboring countries, such as Kenya.

These include a cholera outbreak in South Sudan, another cholera outbreak in the Democratic Republic of Congo – due to the influx of refugees from Burundi – and Ebola in West Arica, among others.

The Emergency Operation Center is under the direct control of the Director General of Health Services in the Ministry of Health.

Kasozi said that, “If something comes up and it is newsworthy, we immediately communicate it to the surveillance division which takes immediate action and prepares to get on the ground.”

The center also has a laboratory specialist and a geographical information system specialist who, immediately after a disease outbreak is confirmed in any part of the country, finds the exact location of the outbreak before the rapid response teams are sent to investigate and respond to the situation.

Apart from Twitter, Uganda also gets information about disease outbreaks from the World Health Organization, the Center for Disease Control in the United States and ProMed.

Dr. Makumbi said that Uganda remains vulnerable to disease outbreaks because it is located near a hotspot known as the Congo basin, “which is a pool of new and old germs which can cause outbreaks, especially from wild animals.”

Uganda is also within the yellow fever and meningitis belts, which both produce outbreaks.

With regards to diseases imported from neighboring countries, Dr. Makumbi said that: “Uganda has porous borders where anyone can come in with any disease and they won’t be noticed.”

A Kutch woman succumbed to Congo fever in Rajkot, while another woman from Dwarka died of swine flu in Jamnagar on Friday.

A 50-year-old woman from Bharudiya village of Bhachau taluka of Kutch succumbed to Crimean Congo hemorrhagic fever (CCHF), commonly known as Congo fever on Friday morning [21 Aug 2015] in a private hospital in Rajkot. According to Dr Pankajkumar Pandey, chief district health officer (CDHO), Kutch, the woman was tested positive for Congo [Crimean-Congo Hemorrhagic] fever [during July 2015] and was brought to hospital in Rajkot where she died on Friday [21 Aug 2015].

[Also during July 2015], a 55-year-old woman from Rampara Vekra village in Mandvi taluka of Kutch district died of Congo fever. "We have deployed medical teams in the village to determine whether other people are having symptoms of Congo fever. A team of veterinary officials are also camping [temporarily living] in the village as well," said a health official from Kutch district.

[This is the 2nd report of CCHF cases from the Kutch district in 2015. There was 1 previous suspected case and 2 confirmed cases, also from the Kutch district of Gujarat state reported on 18 Feb 2015, 29 Mar 2015, and 16 July 2015. CCHF virus is endemic in Gujarat state, and human cases have occurred there as recently as last year (2014). The way in which this and previously reported CCHF virus infections were acquired is not stated. Perhaps the veterinary and public health teams investigating the situation in the village will be able to determine the source of infection. As noted in ProMED-mail archive no. 20150128.3124546, the virus is transmitted by _Hyalomma_ spp. ticks or through contact with infected human blood or animal blood and tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers, and veterinarians. Exposure in health care facilities also occurs. The length of the incubation period depends on the mode of acquisition of the virus. Following infection by a tick bite, the incubation period is usually 1-3 days, with a maximum of 9 days.

The CDC states, "Crimean-Congo hemorrhagic fever (CCHF) is caused by infection with a tick-borne virus (_Nairovirus_) in the family _Bunyaviridae_. The disease was initially characterized in the Crimea in 1944 and given the name Crimean hemorrhagic fever. It was then later recognized in 1969 as the cause of illness in the Congo, thus resulting in the current name of the disease.

The virus is sensitive in vitro to the antiviral drug ribavirin. It has been used in the treatment of CCHF patients, reportedly with some benefit (http://www.cdc.gov/vhf/crimean-congo/). However, since the patient died so soon after admission, effective use of the drug in the treatment of the case above would not have been possible.

Tuesday, August 25, 2015

JAPANESE ENCEPHALITIS AND OTHER - INDIA (11): (MEGHALAYA)*********************************************************A ProMED-mail posthttp://www.promedmail.orgProMED-mail is a program of theInternational Society for Infectious Diseaseshttp://www.isid.org

Meghalaya has sounded an alert for Japanese encephalitis [JE] after 3 people died of the disease and another 6 were tested positive for the virus, an official said on Tuesday [18 Aug 2015].

"We have sounded a health alert in the state after 3 people died of Japanese encephalitis and 6 people were tested for the virus," Director of Health Services R. Wankhar said.

State Health and Family Welfare Minister Alexander Hek, after a meeting with medical officials, said the government has taken steps to contain the spread of the virus. Health officials will also undertake fogging in various localities to tackle _Culex_ mosquitoes, which are responsible for the outbreak of Japanese encephalitis, and their breeding grounds.

"We have directed the hospital authorities to provide adequate treatment and medicines to those suffering from the disease," Hek said.

Encephalitis results in inflammation of the brain, affecting the patient's central nervous system. It is caused by bacterial or viral infections of the brain, injection of toxic substances, or increased complications of an infectious disease.

While the lesser symptoms include headache and fever, the more severe ones cause seizures, confusion, disorientation, tremors, and hallucinations. Japanese encephalitis syndrome is [caused by] a mosquito-borne virus. While humans are the dead-end hosts of the virus, pigs act as amplifying hosts that aid in spread of the virus.

--Communicated by:ProMED-mail

[The 3 cases mentioned above are doubtless the same 3 that were reported on 15 Aug 2015 (ProMED-mail archive no. 20150815.3581103), but the other 6 positive cases are new, suggesting that JE virus infections are a bit more frequent than earlier indicated. There have been numerous JE cases in northeastern India again in 2015. Since this area is in the JE virus endemic area, with human cases occurring every year, these additional cases are not surprising.

While the municipal health department has denied the incidence of [infections with a] hantavirus, a rare but deadly virus [clinically] similar to the leptospirosis pathogen, in Mumbai, a private diagnostic laboratory in the city that tested blood samples for the presence of the virus found 14 positive cases in the past 1.5 years.

On 4 Aug [2015], the Hindustan Times reported that the blood sample from a Kurla resident who was admitted to private hospital in Ghatkopar in July 2015 indicated that he had [a] hantavirus [infection] [see ProMED-mail archive no. 20150805.3560460]. The patient is now cured.

Following the report, the Brihanmumbai Municipal Corporation (BMC) collected blood samples from the patient and sent them for confirmatory tests to the National Institute of Virology (NIV) in Pune, but the reports were negative. Metropolis, a chain of pathology lab across the country, tested as many as 114 suspected samples of hantavirus, of which 14 were positive.

"Ours is a laboratory with pan-India presence, and it is not just Mumbai that we receive samples from but from all over the country. And we have positive cases of hantavirus [infection] from all over. In Mumbai alone, from 2014 to now we have had enough positive cases that show that the virus is very much present," said Dr Nilesh Shah, group president, scientific services and operations, west India, Metropolis.

The BMC said it is unaware of the new cases and it would have to investigate further and contact the lab for details. "We do not have any knowledge about the 14 cases. We will have to get in touch with the lab for further details," said Dr Mini Khetarpal, chief of epidemiology, BMC.

However, the civic body maintained that a hantavirus was not present in the city. "We cannot say for sure that there is hantavirus in light of the new cases that have been brought up. However, in our meeting with Bombay Veterinary College we were assured that no tests revealed the presence of virus in the city," he added. [But] "It would be unwise to say that are no hantavirus cases in the city. It is a matter of referring the cases for diagnosis for the said virus and reporting," said Dr Om Srivastava, infectious diseases expert at Jaslok Hospital. "In theory, it can be said that the antibodies will be present in the body. However, in this particular case it is unlikely that it will test positive, as there has been a significant delay in collecting the blood sample," he added. [This is incorrect. It is only the virus that disappears from the bpdy with time -- the antibodies remain and increase. - Mod.JW]

[Byline: Shobhan Singh]

--Communicated by:ProMED-mail from HealthMap Alerts

[It is difficult to draw conclusions from the information provided in the report above regarding whether the patient reported on 4 Aug 2015 had a hantavirus infection or not. Initially, the diagnosis was made on clinical grounds (respiratory disease), but the results from the NIV, the national reference laboratory, were negative. It is equally difficult to conclude whether there are human hantavirus infections in Mumbai. The private laboratory reported that 14 blood samples tested positive, presumably for hantavirus antibodies. The type of test used is not specified nor is the particular hantavirus [tested for].

Cases of hantavirus infections in humans in India are reported occasionally. The most recent cases of reported suspected hantavirus infections in India were in January 2014 in Kerala and October 2011in Andhra Pradesh, where there were 3 cases of a suspected hantavirus infection in Nellore. The specific hantavirus involved in these cases was not stated either. In Asia, the 5 recognized hantaviruses with their main rodent reservoir species are: Hantaan virus (_Apodemus agrarius_), Amur virus (_A. peninsulae_), Thailand virus (_Bandicota indica_), Seoul virus (widely distributed worldwide in _Rattus norvegicus_), and Muju virus (_Myodes regulus_).

In a 4 Feb 2010 ProMED-mail post (archive no. 20100205.0385), it was reported that Dr J. Clement and colleagues from the National Reference Laboratory for Hantavirus Infections, University Hospital Gasthuisberg, Leuven, Belgium found evidence in India of the murine Seoul virus (SEOV) infection and also of the arvicoline Puumala virus (PUUV) infection, the latter in 2 fatal cases (from the Cochin and Chennai regions, respectively) with acute respiratory syndrome, symptoms similar to those in the more recently described Nellore cases in 2011 (see ProMED-mail archive no. 20111026.3187) as well as in the case described in 2011.

Comment: In my opinion the main problems are two fold. It is inconvenient since the center is open only twice a week. No one answers the phone usually, so you are never really sure if you would actually be able to get the injection if you are coming from a far off place.The use of multi-dose vial, and the use of a generic non standard Yellow Fever vaccines are other issues that you need to be aware of.The good news is that they have an online registration system for travelers, You can try it hereUnfortunately, I am not aware of any private centers doing the Yellow Fever vaccination in an appropriate way in Hyderabad.Any feedback from people taking the vaccination at this (or any other center) would be appreciated.DISCLAIMER : All the information is taken from the govt websites, and I am not liable for any changes/ errors. Please confirm with the local authorities for any changes in the schedule / pricing.

I have gotten a lot of queries regarding Yellow Fever Vaccination Center in South india. I am posting the details here for Chennai Center for Yellow Fever Vaccination

CONTACT ADDRESS:

International vaccination centre

King Institute of Preventive

Medicine & Research, Guindy ,Chennai –600032

Phone : 044-22501520

Ext : 127, 128

Email ID : kipmguindy@yahoo.com

ACTIVITIES OF INTERNATIONAL VACCINATION CENTRE

I. YELLOW FEVER VACCINE:

Vaccination against yellow fever for International Travellers is being done on Fridays from 10.00 am to 3.00 pm and the certificate issued immediately. (If Friday is a holiday it’s done on the previous working day)

FEE : Rs. 200 / 500 dose

Mandatory requirement : Passport

Immunity begins from 10 days after Vaccination and lasts for 10 years.

The vaccine is a freeze–dried virus containing chick embryo tissues infected with attenuated yellow fever virus strain 17D. The vaccine meets WHO requirements .It is obtained from CRI Kasauli, which procures it from Federal state unitary Enterprise on manufacture of Bacterial and viral preparations (Russian Academy of Medical Sciences)

Utilization of vaccine per week : 100 – 120 doses

Annual performance : 2010 – 2011 - 4700

Allergic manifestations to the vaccine : NIL reported till date

Travellers have been injected and issued the certificate of Vaccination on the same day.

SourceThere is another center in Port Health organization, here are its details

XI. Vaccination against Yellow Fever

Instructions for Yellow Fever Vaccination

Yellow fever vaccination is given on demand at a nominal charge of Rs.300/- on Wednesdays and Fridays between 10AM to 1.00PM

Port health Organisation is the only centre in Kerala authorized by Ministry of Health & Family Welfare to provide Yellow Fever Vaccination for passengers travelling to Yellow Fever affected countries in Africa and South America.

Port Health Organisation, Cochin is located in Willingdon Island. The Office is located in the north end of the island opposite Customs House and next to Mercantile Marine Department (MMD).

Passengers for Yellow Fever Vaccination are to report to vaccination centre before 10 O’ clock along with Passport/ photocopy of the Passport. After reaching the centre please register your name in the registration slip and fill up the Consent Form for vaccination. The vaccination will start after 11 AM.

The validity of the Yellow Fever Vaccination starts from the 10th day of the vaccination to 10 years and a re-vaccination is required on completion of 10 years.

Passengers going to Kenya, Nigeria, Ethiopia, Syria, Somalia, Afghanistan and Pakistan should take Polio Vaccination alongwith Yellow Fever Vaccination. Passengers should inform the Registration Clerk about the countries they intend to visit. PHO, Cochin has made arrangement for Oral Polio Vaccination to be given along with Yellow Fever Vaccination. The passengers are required to take the Oral Polio Vaccination 4 weeks prior to visiting the Polio affected countries. The Oral Polio Vaccine is valid for 1 Year.

The passengers who have taken the Yellow Fever Vaccination are also requested to inform the Port Health Organisation about serious/ life threatening side effects, if any, they had within 1 month of the vaccination in writing to Port Health Officer at the following E-mail ID – phocochin@yahoo.co.in or by phone 0484 2666060. The side effects includes continues fever/ pain or lump at the site of injection, allergy, breathlessness, asthma, itching at the site of injection or severe anaphylactic reaction following the vaccination.

Duplicate Yellow Fever Vaccination card is issued to persons who have lost the Yellow Fever card on production of

Comment: In my opinion the main problems are two fold. It is inconvenient since the center is open only once a week. No one answers the phone usually, so you are never really sure if you would actually be able to get the injection if you are coming from a far off place.The use of multi-dose vial, and the use of a generic non standard Yellow Fever vaccine are other issues that you need to be aware of.Unfortunately, I am not aware of any private centers doing the same in Chennai.Any feedback from people taking the vaccination at this (or any other center) would be appreciatedDISCLAIMER : All the information is taken from the govt websites, and I am not liable for any changes/ errors. Please confirm with the local authorities for any changes in the schedule / pricing.

My name is **** and I am from Bangalore. I travel to Uganda in a few days. I just realised that I need to get yellow fever vaccination. I called the public health office in Bangalore and I may or may not be able to get the vaccination done on Wednesday. I arrive in Uganda on Friday afternoon. I was wondering if having the two days in between is sufficient for the vaccination to take effect. Online it says that it takes about ten days for it to take effect.

I know that as a doctor you would obviously not advise me to take the risk of travelling without getting the proper vaccination, but, I was wondering if I was willing to take the risk, does the government have a policy against me immigrating if I haven't given it the recommended period of ten days? I return from Uganda in two weeks from now.

Thanks so much! I shall be very grateful if you could reply to me at your earliest convenience.

Ans. Hi,

Thanks for contacting me,

You are correct in understanding that the Yellow Fever Vaccine takes 10 days for effect as per the government notification.

The government / immigration policy can put you in quarantine, or even deport you in case you have not waited for the mandatory 10 days period. You may be treated as someone NOT possessing the Yellow fever Vaccination certificate.

While this is usually not the case in real life, it is certainly a possibility, and hence I would recommend that you consider postponing the trip by a few days if possible,

Friday, August 21, 2015

At the 250th National Meeting & Exposition of the American Chemical Society this week, researchers from MIT, Harvard Med School, and the FDA are showing off a new field test that can quickly screen people for Ebola, yellow fever, and dengue. While the researchers don’t claim their technique to be as accurate as PCR and ELISA, it is nevertheless an excellent tool in poor areas of the world where these diseases tend to thrive.

The test doesn’t require any water or electricity nor any complicated and expensive equipment. It works similar to pregnancy tests, providing a color readout that signals whether a disease is detected that is easily readable by just about anyone.

The technology relies on silver nanoparticles produced to be of different sizes. Each nanoparticle size reflects light of different frequency, having a particular color when looked at with the naked eye. These silver nanoparticles are attached to antibodies that stick to proteins associated with Ebola, yellow fever, and dengue. A special paper strip is then used to mix the nanoparticle-antibody compounds with samples of patient blood. When a antibody meets a protein it likes, the two snap together and move down the paper strip. Another antibody that sticks to the same protein waits further down the strip. When it does attach to the complex, the whole becomes too large to travel any further down the strip. This is evident by seeing a specific color appear and stay on the test strip, which indicates the presence of a specific disease.

The team behind the test is now working on distributing the test freely in regions where it would have the most benefit. Moreover, they want to help locals build their own test kits that they can distribute quickly as needed.

About Me

I am a pediatrician based at Mohali, a suburb of chandigarh, North India. I have my own virtual office at www.charakclinics.com; I have been a pediatrician since 1994. I hope to make ths blog a regular feature with tonnes of relevant info for parents, especially in India, because i feel that "informed parents are better parents". My interests include research in OPD practice, specifically new vaccines and travel medicine. I am a member of American Academy of Pediatrics, Indian Academy of Pediatrics, and various travel organizations like International Society for Travel Medicine (ISTM), American Society of Tropical Medicine & Hygiene (ASTMH), International Association for Medical Assistance to Travelers (IAMAT), and British & Global Travel Health Association (BGTHA)